In Praise of Waste Removal

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(This is the fourth of five articles I’m writing about things I learned from my recent medical experiences. It is by far the most personal.)

It’s no secret that I wasn’t raised Orthodox, though my family always had such leanings. My parents switched the family from a large, ornate Reform temple to a humble shtiebel when I was in fifth grade, and I switched to yeshiva when I was in eighth grade. The following story occurs in the context of my pre-Orthodox upbringing.

When I was around eight, my older sister attended a religious summer camp. My parents and I went up for visiting day and even now, [redacted] years later, I remember my sister’s comment verbatim: “You can’t even go to the bathroom around here without making a bracha!”

I thought that was a wonderfully witty bit of hyperbole on her part, though at the time I would have been hard-pressed to refer to it as such. It would be another five years before I realized that she was speaking literally. It wasn’t until recently that I truly came to appreciate it.

As readers of my most recent pieces are aware, I recently underwent spine surgery. There was a minor complication during my procedure, which meant that, after I came out of the anesthesia, I had to lie flat on my back for about eight hours. So here I was, with a large, fresh incision down my back, which you can imagine was the source of some discomfort. And I had to lie flat on my back for many hours which, if you’re not asleep, is not as much fun as you might think. (Seriously, lie down on your bed and just stare at the ceiling for two or three hours. I assure you that it will get tired pretty quickly.) But none of this made any difference to me. I just wanted to go to the bathroom.

It wasn’t the fact that I was supine on a gurney that was the problem; hospitals are equipped to deal with that. It quickly became apparent that I was suffering an additional complication: postoperative urinary retention (POUR, or sometimes PUR).

POUR is a not-uncommon side effect of anesthesia. Like all good 21st-century hypochondriacs patients, I Googled it and, sure enough, I checked all the boxes for likelihood of this condition. Male (check), of a certain age (getting there), increasingly-likely the longer one is under anesthesia (which, thanks to the other, aforementioned complication, was much longer than originally expected). The treatment for POUR is to catheterize the patient, which I requested. Unfortunately, the nurses were not willing to do that without clearance from my doctor or his PA. Since they were in another surgery, I had to wait quite a few hours before they could approve this request.

My verbal skills are insufficient to describe the urgency I felt in addressing this need. Imagine you’re on the highway and you feel the need to relieve your bladder but the nearest rest stop is another 13 miles away. That’s not even close. An adult bladder normally holds 300-400 ml. Catheterization for POUR is recommended when the bladder volume is about 600 ml. By the time I was catheterized, I was well over 900 ml. (I don’t know what the record is but I have no interest in pursuing it.)

The purpose of my surgery was to (hopefully) restore my ability to stand up straight and walk unassisted. As I lay in my hospital bed on the day after my surgery, I was far more concerned with the POUR. I was especially anxious to see that the condition was resolved when the catheter was removed. Yes, I would like to be able walk as I used to but, in pursuit of that goal, I gained a far greater appreciation for another bodily function that most of us take for granted: waste removal.

Asher yatzar, the blessing recited after relieving one’s bladder and/or bowel, is a fairly long bracha as such things go and, unlike bentching, it doesn’t have a catchy tune to help one commit it to memory. It’s recited after performing some natural but not particularly dignified bodily functions, which doesn’t help its popularity any. In it, we thank God, “Who formed man with wisdom, creating within him many ducts and tubes. It is revealed and known before the seat of Your glory that if but one of these were to become ruptured or blocked, it would be impossible for us to endure and to stand before You, even for a brief period. Blessed are You, Hashem, Who heals all flesh and performs wonders.”

This bracha was formulated by the Anshei Knesses HaGedola (Men of the Great Assembly) and the text is provided in Talmud Brachos (60b). The phrase “asher yatzar,” from which the bracha gets its name, is actually taken from Genesis 2:8, “Hashem God planted a garden to the east, in Eden, and there He put the man whom He had formed.” We tend to overlook the significance of this bracha because, baruch Hashem, most of us have been going to the bathroom since the age of three without giving the matter much thought.

Asher yatzar may not be the only bracha we take for granted (remind me to tell you about Shehakol some time) but it certainly tops the list. Last week, I wrote about things for which I have learned to be grateful. The gift of waste removal deserves a shout-out all its own because most of us don’t really appreciate how crucial and precious it truly is.

Our Sages certainly don’t need my endorsement but I will nevertheless express that they had it exactly right when they said that if our intricate ductwork were not to function properly, we would be unable to endure and to stand before God, even briefly. They were also spot on in ending this blessing that God performs wonders because our various bodily systems – respiratory, circulatory, reproductive, digestive, etc. – are truly incredible things for Him to have designed and created, and the ways in which He maintains them all in tandem is nothing short of a continuous, ongoing miracle. I hope that no one ever has to lose this remarkable ability, even temporarily, to be able to appreciate it.


Rabbi Jack Abramowitz is Torah Content Editor at the Orthodox Union. He is the author of six books, including The Tzniyus Book and The Taryag Companion. His latest work, The God Book, is available from OU Press as well as on Amazon.

The words of this author reflect his/her own opinions and do not necessarily represent the official position of the Orthodox Union.